Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
Trials ; 22(1): 595, 2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1398873

ABSTRACT

BACKGROUND: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. METHODS: A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. DISCUSSION: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04466007 . Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Hematopoietic Stem Cell Transplantation , Mesenchymal Stem Cells , Noma , Adipose Tissue , Animals , Clinical Trials, Phase II as Topic , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/therapy , Double-Blind Method , Humans , Ischemia/diagnosis , Ischemia/therapy , Multicenter Studies as Topic , Quality of Life , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome
3.
Semin Vasc Surg ; 34(3): 89-95, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1313630

ABSTRACT

The COVID-19 pandemic negatively impacted patients with conditions that are associated with significant morbidity, but might not be immediately life-threatening. Patients with chronic limb-threatening ischemia (CLTI) were affected by delays in care, potentially increasing major limb amputations. This study sought to review strategies employed, and limb salvage outcomes reported, during the COVID-19 pandemic. We performed a literature review of the electronic database PubMed from December 2019 to December 2020. Articles subjected to analysis must have had a specific CLTI group before the pandemic to compare to the pandemic group. Case reports, case series, and non-CLTI comparisons were excluded. The literature search yielded 55 articles for review, of which 6 articles met criteria for analysis. The main classifications used for disease stratification included Rutherford, Fontaine, and SVS WIfI (Wound, Ischemia, Foot Infection). Overall, a decrease in vascular clinical volume was reported, ranging from 29% to 54%. A higher major limb amputation rate (2.6% to 32.2%) during the pandemic surge was reported in 5 of 6 publications. Four of 6 studies also reported minor amputations; 3 of these demonstrated an increase in minor amputations (7% to 17.7%). The CLTI population is vulnerable and it appears that both minor and major amputation rates increased in this population during the pandemic. The limited data available in CLTI patients during the COVID-19 pandemic and use of different stratifications schemes in areas impacted to variable extents prevent recommendations for the best treatment strategy. Further data are required to improve strategies for treating this population to minimize negative outcomes.


Subject(s)
COVID-19 , Peripheral Arterial Disease , Amputation , Chronic Disease , Humans , Ischemia/diagnosis , Ischemia/epidemiology , Ischemia/surgery , Limb Salvage , Pandemics , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome
4.
Urol Int ; 105(9-10): 916-919, 2021.
Article in English | MEDLINE | ID: covidwho-1262425

ABSTRACT

Infection by COVID-19, being a respiratory disease caused by SARS-CoV-2, can predispose to arterial and venous thrombotic disease, in response to excessive inflammation, platelet activation, endothelial dysfunction, and venous stasis. During the COVID-19 pandemic period, the technological and resource availability for the care of these patients with thrombotic disease is critical, marking a factor of morbidity and poor prognosis in these cases. We describe a case of priapism in a patient with COVID-19, during the course of systemic inflammatory response syndrome and respiratory distress syndrome with a procoagulant state, seeking to relate the pathophysiological factors of ischemic priapism in patients with infection with SARS-Cov-2.


Subject(s)
COVID-19/complications , Ischemia/etiology , Penile Erection , Penis/blood supply , Priapism/etiology , Adult , COVID-19/diagnosis , COVID-19/virology , Fatal Outcome , Humans , Ischemia/diagnosis , Ischemia/physiopathology , Male , Priapism/diagnosis , Priapism/physiopathology , Regional Blood Flow
6.
Am J Surg Pathol ; 46(1): 89-96, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1254925

ABSTRACT

Approximately 20% of patients with symptomatic syndrome-associated coronavirus-2 (SARS-CoV-2) infection have gastrointestinal bleeding and/or diarrhea. Most are managed without endoscopic evaluation because the risk of practitioner infection outweighs the value of biopsy analysis unless symptoms are life-threatening. As a result, much of what is known about the gastrointestinal manifestations of coronavirus disease-2019 (COVID-19) has been gleaned from surgical and autopsy cases that suffer from extensive ischemic injury and/or poor preservation. There are no detailed reports describing any other gastrointestinal effects of SARS-CoV-2 even though >3,000,000 people have died from COVID-19 worldwide. The purpose of this study is to report the intestinal findings related to SARS-CoV-2 infection by way of a small case series including one with evidence of direct viral cytopathic effect and 2 with secondary injury attributed to viral infection. Infection can be confirmed by immunohistochemical stains directed against SARS-CoV-2 spike protein, in situ hybridization for spike protein-encoding RNA, and ultrastructural visualization of viruses within the epithelium. It induces cytoplasmic blebs and tufted epithelial cells without inflammation and may not cause symptoms. In contrast, SARS-CoV-2 infection can cause gastrointestinal symptoms after the virus is no longer detected, reflecting systemic activation of cytokine and complement cascades rather than direct viral injury. Reversible mucosal ischemia features microvascular injury with hemorrhage, small vessel thrombosis, and platelet-rich thrombi. Systemic cytokine elaboration and dysbiosis likely explain epithelial cell injury that accompanies diarrheal symptoms. These observations are consistent with clinical and in vitro data and contribute to our understanding of the protean manifestations of COVID-19.


Subject(s)
COVID-19/pathology , Intestinal Diseases/pathology , Intestinal Diseases/virology , Intestines/pathology , Intestines/virology , Adult , Aged , Aged, 80 and over , Biomarkers/metabolism , Biopsy , COVID-19/diagnosis , COVID-19/immunology , Cytokines/metabolism , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/immunology , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/virology , Humans , Intestinal Diseases/diagnosis , Intestinal Diseases/immunology , Intestines/immunology , Ischemia/diagnosis , Ischemia/immunology , Ischemia/pathology , Ischemia/virology , Male , Thrombosis/diagnosis , Thrombosis/immunology , Thrombosis/pathology , Thrombosis/virology
7.
Semin Vasc Surg ; 34(2): 8-12, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1240793

ABSTRACT

This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient's clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.


Subject(s)
COVID-19/complications , Ischemia/therapy , Ischemia/virology , Lower Extremity/blood supply , Thrombosis/therapy , Thrombosis/virology , Anticoagulants/therapeutic use , COVID-19/diagnosis , COVID-19/therapy , Humans , Ischemia/diagnosis , Thrombectomy , Thrombosis/diagnosis
8.
Ann R Coll Surg Engl ; 103(5): e151-e155, 2021 May.
Article in English | MEDLINE | ID: covidwho-1238751

ABSTRACT

The diagnosis of visceral perforation during pregnancy is often delayed and the management complex. A 32-year-old primigravid woman in her second trimester presented with abdominal pain and a pre-existing ileoanal pouch. Initial imaging was negative but later imaging was suggestive of serious pathology. At laparotomy, a caesarean section was performed. Peritonitis was encountered secondary to two discrete perforations in the small bowel separate from her pouch. Histology found an ischaemic perforation secondary to a pressure effect from the gravid uterus. In pregnancy, ileoanal pouches may make the interconnected bowel vulnerable to the pressure effect of the gravid uterus and perforation. Pregnant women with such a surgical history who develop symptoms suggestive of bowel perforation should have rapid imaging and their clinical team should consider early definitive surgical intervention.


Subject(s)
Colonic Pouches , Inflammatory Bowel Diseases/complications , Intestinal Perforation , Ischemia , Pregnancy Complications , Abdominal Pain , Adult , Cesarean Section , Female , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Intestine, Small/surgery , Ischemia/diagnosis , Ischemia/surgery , Laparotomy , Peritonitis/diagnosis , Peritonitis/surgery , Pregnancy
9.
Pan Afr Med J ; 38: 275, 2021.
Article in English | MEDLINE | ID: covidwho-1190642

ABSTRACT

Since the spread of the coronavirus disease 2019 (COVID-19) pandemic, cardiovascular complications are interestingly increasing, particularly thrombotic events, especially in those requiring intensive care. Venous thromboembolism is well known to occur in patients infected by the SARS-CoV-2, but only a few arterial thromboembolism cases have been previously reported. Herein, we report the case of a COVID-19 complicated by a concomitant acute right limb ischemia and multiple acute ischemic strokes. This rare case emphasizes the hypercoagulable state described in COVID-19 patients and the need for anticoagulation therapy to prevent these severe complications.


Subject(s)
COVID-19/complications , Ischemia/diagnosis , Ischemic Stroke/diagnosis , Thromboembolism/diagnosis , Acute Disease , Aged , Humans , Ischemia/virology , Ischemic Stroke/virology , Male , Thromboembolism/virology
10.
Turk Kardiyol Dern Ars ; 49(3): 233-236, 2021 04.
Article in English | MEDLINE | ID: covidwho-1181749

ABSTRACT

As the COVID-19 pandemic continues, its novel complications are being increasingly recognized, and new mechanisms of the disease are being unraveled. Aortic free-floating thrombus is exceptionally rare, and prompt diagnosis is vital to alleviate its detrimental end organ effects. We present a patient who was previously discharged owing to COVID-19 pneumonia, admitted with acute onset of lower limb pain, and was diagnosed with aortic free-floating thrombus ended up with embolic events. Clinicians should be aware of COVID-19-related thromboembolic complications, and close monitoring of patients with risk factors is vital for a timely and accurate diagnosis and management.


Subject(s)
COVID-19/complications , Infarction/etiology , Ischemia/etiology , Kidney/blood supply , Lower Extremity/blood supply , Thromboembolism/etiology , Aortic Diseases/diagnosis , Aortic Diseases/etiology , Humans , Infarction/diagnosis , Ischemia/diagnosis , Male , Middle Aged , SARS-CoV-2 , Thromboembolism/diagnosis , Thrombosis/diagnosis , Thrombosis/etiology
11.
J Thromb Thrombolysis ; 52(3): 974-979, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1163124

ABSTRACT

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic across the world. Hypercoagulability status in COVID-19 is one of the causes of complication from severe COVID-19 with a high risk of arterial thrombosis. Acute Limb Ischemia is a vascular emergency caused by sudden decrease in the arterial perfusion. We report the case of a 53-year-old male patient with COVID-19 Pneumonia, diagnosed with Acute Limb Ischemia. From clinical examination, which included anamnesis, physical examination, and laboratory results as well as chest X-rays, a suspicion of Acute Limb Ischemia was found in a patient with COVID-19 pneumonia. The SARS-CoV-2 real time PCR examination showed positive results. In this patient, the diagnosis of Acute Limb Ischemia with Covid-19 Pneumonia was established through a multidisciplinary approach covering the fields of pulmonology, cardiology, and thoracic and cardiovascular surgery.


Subject(s)
COVID-19/complications , Ischemia/etiology , Lower Extremity/blood supply , Peripheral Arterial Disease/etiology , Thrombosis/etiology , Acute Disease , Anticoagulants/therapeutic use , COVID-19/diagnosis , COVID-19/therapy , Fibrinolytic Agents/therapeutic use , Humans , Ischemia/diagnosis , Ischemia/therapy , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/therapy , Thrombectomy , Thrombosis/diagnosis , Thrombosis/therapy , Treatment Outcome
13.
Vasc Health Risk Manag ; 16: 467-478, 2020.
Article in English | MEDLINE | ID: covidwho-954969

ABSTRACT

Aim: In addition to its respiratory impact of SARS-CoV2, skin lesions of probable vascular origin have been described. This study intends to quantify the incidence of acro-ischemic lesions in COVID-19 infected adult subjects in our population, describing clinical patterns and associated findings. Methods: All adult confirmed cases of COVID-19 infection who presented with acro-ischemic lesions and received care in our institution were prospectively enrolled up to May 15th, 2020. The variables included demographics, comorbidities, analytical parameters, clinical presentations and COVID-19 treatment. Results: We enrolled 24 patients. The overall rate of acro-ischemic findings in COVID-19 patients was 1.2% [0.6% for outpatients and 2.9% for hospitalized (ICU and non-ICU patients)], but the observed incidence for acro-ischemia in ICU patients was remarkably higher (23.0%, p<0.001). We have described four different clinical patterns of acroischemia: atypical Raynaud´s phenomenon (ARP), (4); pseudo-pernio (PP), (5); severe microcirculatory ischemia with preserved pulse (SMI), (6); and dry gangrene with arteriosclerosis obliterans (AO), (9). Kendall´s τ correlation with lung disease severity was 0.877 (95% CI, 0.756 to 0.968); p<0.01). ARP individuals were predominantly female, while SMI appeared lately in elderly hospitalized subjects with better prognosis. AO occurred in patients with more comorbidity and younger than those with SMI. We observed other associated lesions of suggestive ischemic nature in other organs in all groups (15 patients of total sample). Plasma procalcitonin was significantly higher in patients who developed SMI (median and interquartile range: 9.99 (4.2, 12.3) mg/mL vs 0.26 (0.11, 0.89) mg/mL; p<0.001), and D-dimer level at hospital admission was significantly higher in AO patients (median and interquartile range: 1166 (1050, 2111) mg/L vs 502 (448, 777) mg/L; p<0.001). Conclusion: The observed risk for acroischemia in COVID-19 is high in ICU patients (23%). We have described four different clinical patterns of acroischemia (ARP, PP, SMI and AO) associated with lung disease severity. Authors have communicated various lesions of suggestive ischemic nature in other organs. Raynaud-like pattern is reported as a "novelty".


Subject(s)
COVID-19/epidemiology , Chilblains/epidemiology , Ischemia/epidemiology , Raynaud Disease/epidemiology , Skin/blood supply , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/drug therapy , Chilblains/diagnosis , Chilblains/drug therapy , Comorbidity , Female , Gangrene , Humans , Incidence , Ischemia/diagnosis , Ischemia/drug therapy , Male , Middle Aged , Prognosis , Prospective Studies , Raynaud Disease/diagnosis , Raynaud Disease/drug therapy , Risk Factors , Skin/pathology , Spain/epidemiology
14.
J Vasc Surg ; 72(6): 1850-1855, 2020 12.
Article in English | MEDLINE | ID: covidwho-872335

ABSTRACT

With the aggressive resource conservation necessary to face the coronavirus disease 2019 pandemic, vascular surgeons have faced unique challenges in managing the health of their high-risk patients. An early analysis of patient outcomes after pandemic-related practice changes suggested that patients with chronic limb threatening ischemia have been presenting with more severe foot infections and are more likely to require major limb amputation compared with 6 months previously. As our society and health care system adapt to the new changes required in the post-coronavirus disease 2019 era, it is critical that we pay special attention to the most vulnerable subsets of patients with vascular disease, particularly those with chronic limb threatening ischemia and limited access to care.


Subject(s)
COVID-19 , Diabetic Foot/surgery , Health Services Accessibility/trends , Ischemia/surgery , Patient Acceptance of Health Care , Peripheral Arterial Disease/surgery , Vascular Surgical Procedures/trends , Amputation/trends , Chronic Disease , Diabetic Foot/diagnosis , Humans , Ischemia/diagnosis , Limb Salvage/trends , Peripheral Arterial Disease/diagnosis , Program Evaluation , San Francisco , Time-to-Treatment/trends , Treatment Outcome , Triage/trends
15.
Ann Vasc Surg ; 69: 80-84, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-703963

ABSTRACT

Novel 2019 coronavirus (COVID-19) infection usually causes a respiratory disease that may vary in severity from mild symptoms to severe pneumonia with multiple organ failure. Coagulation abnormalities are frequent, and reports suggest that COVID-19 may predispose to venous and arterial thrombotic complications. We report a case of acute lower limb ischemia and resistance to heparin as the onset of COVID-19 disease, preceding the development of respiratory failure. This case highlights that the shift of coagulation profile toward hypercoagulability was associated with the acute ischemic event and influenced the therapy.


Subject(s)
Coronavirus Infections/diagnosis , Ischemia/diagnosis , Ischemia/therapy , Lower Extremity/blood supply , Pneumonia, Viral/diagnosis , Acute Disease , Anticoagulants/administration & dosage , Betacoronavirus , Biomarkers/blood , COVID-19 , Diagnosis, Differential , Diagnostic Imaging , Heparin/administration & dosage , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Thrombectomy , Thrombophilia/complications , Thrombophilia/drug therapy
SELECTION OF CITATIONS
SEARCH DETAIL
...